Background: Postural health is essential for preventing musculoskeletal disorders (MSDs) such as back pain, cervical strain, and spinal degeneration. In hilly regions like Himachal Pradesh, daily physical activities and occupational strains increase vulnerability to posture-related issues. This study aimed to assess the knowledge, attitudes, and practices (KAP) related to postural health among the general population of Himachal Pradesh and to evaluate how socio-demographic factors influence awareness and risk behavior. Materials and Methods: A descriptive, cross-sectional survey was conducted among 400 adults across various districts of Himachal Pradesh using a structured, self-administered Google Form questionnaire in English and Hindi. Participants were selected through purposive and convenience sampling, excluding individuals professionally trained in healthcare or ergonomics. The questionnaire assessed socio-demographics, postural knowledge (20 MCQs), attitudes, and self-care practices. Knowledge scores were categorized as Very Good (17–20), Good (13–16), Fair (9–12), and Poor (0–8). Data were analyzed using Epi Info Version 7 with chi-square tests to assess associations between knowledge levels and demographic variables (p < 0.05). Results: Among 400 participants, 65% demonstrated either Good (34.5%) or Very Good (30.5%) postural health knowledge. High awareness was observed regarding the definition of posture (71.5%), role of exercise (78.0%), screen use (69.3%), lifting techniques (73.3%), and benefits of walking (74.8%). However, gaps remained in understanding the limitations of postural braces (62.8%) and the influence of stress on posture (66.5%). Knowledge was significantly associated with age (p = 0.021), education level (p < 0.001), and place of residence (p = 0.034). Urban residents and participants with higher education performed better. Gender was not significantly associated with knowledge levels (p = 0.279). Conclusion: The population of Himachal Pradesh shows encouraging awareness of postural health and its relationship to musculoskeletal well-being. However, critical knowledge gaps persist, especially among older adults, rural residents, and those with lower educational attainment. Targeted, culturally sensitive health education programs are essential to bridge these gaps and promote sustainable, posture-friendly behaviors across all population groups—especially in physically demanding rural environments.
Postural health is a foundational yet often overlooked aspect of overall well-being, significantly influencing musculoskeletal function, occupational performance, and quality of life. Poor posture—whether static or dynamic—can lead to a range of musculoskeletal disorders (MSDs), including chronic back pain, cervical strain, shoulder impingement, and early-onset degenerative changes in the spine. In today's increasingly sedentary lifestyle, particularly among office workers, students, and mobile device users, postural imbalance has emerged as a silent contributor to physical disability and long-term discomfort. While ergonomic education and preventive strategies are gaining traction globally, awareness about postural health remains relatively low among the general population, especially in rural and hilly regions of India [1-4].
Himachal Pradesh presents a unique geographical and sociocultural backdrop for studying posture-related health issues. The hilly terrain necessitates physically strenuous tasks like trekking, farming on steep slopes, and manual load-carrying—activities that, when performed with incorrect biomechanics or prolonged strain, predispose individuals to musculoskeletal problems. Compounding the issue is the lack of ergonomic awareness in both urban and rural residents, with traditional practices, poor infrastructure, and limited access to physiotherapy or occupational health services serving as major barriers. Moreover, school and office environments often lack posturally adaptive furniture or regular health education, further exacerbating the problem from an early age [4-7].
Despite growing clinical evidence linking poor posture with rising rates of musculoskeletal complaints, few community-based studies in India—and virtually none in Himachal Pradesh—have evaluated the public’s understanding of postural health, its risks, and the preventive behaviors necessary to mitigate long-term complications. Misconceptions, negligence, and the normalization of posture-related pain often delay diagnosis and treatment. Therefore, gauging the level of awareness and identifying gaps in knowledge are critical for informing region-specific health promotion efforts and preventive musculoskeletal care [7-12].
This study aims to assess the awareness, attitudes, and practices related to postural health among the general population of Himachal Pradesh, with an emphasis on understanding how socio-demographic factors influence musculoskeletal risk behaviors. By identifying knowledge deficits and common misconceptions, the findings will guide future educational interventions and policy frameworks aimed at improving posture-related health outcomes in both rural and urban settings.
This study adopted a descriptive, cross-sectional design aimed at evaluating the public's knowledge, attitudes, and practices (KAP) related to postural health and its impact on musculoskeletal disorders among the general population of Himachal Pradesh. The objective was to identify awareness levels, behavioral patterns, and misconceptions surrounding posture-related health issues and their consequences.
Study Area and Population
The research was conducted across multiple districts in Himachal Pradesh, encompassing both rural and urban populations to ensure demographic and geographic diversity. Participants included adults aged 18 years and above from varied occupational and educational backgrounds. Individuals professionally trained in healthcare, physiotherapy, or ergonomics were excluded to prevent skewed data from prior clinical knowledge and to maintain the general public focus of the study.
Sample Size and Sampling Technique
A total of 400 participants were selected using a purposive and convenience sampling strategy. The sample size was estimated using standard formulae for population-based awareness studies, considering a 95% confidence level, 5% margin of error, and 50% expected awareness prevalence. The study link was disseminated via digital platforms including WhatsApp, Facebook, email, and local community networks. Local health workers and volunteers helped promote participation, especially in rural and remote areas.
Data Collection Tool
Data were collected using a structured, self-administered Google Form questionnaire developed with inputs from physiotherapists, orthopedic specialists, and public health experts. The questionnaire was provided in both English and Hindi to maximize comprehension and inclusivity.
The questionnaire comprised the following sections:
Socio-Demographic Information – Capturing data on age, gender, education, occupation, and place of residence.
Knowledge Component – Multiple-choice questions evaluating understanding of proper posture, ergonomic practices, common posture-related disorders, and their prevention.
Attitudes and Practices – Questions assessing daily habits such as sitting and lifting posture, screen use behavior, use of ergonomic furniture, exercise routines, and response to musculoskeletal pain or discomfort.
Pilot Testing
The questionnaire was pilot-tested on 30 individuals from diverse backgrounds in Himachal Pradesh to assess clarity, digital accessibility, and content relevance. Based on feedback, necessary adjustments were made to improve the language, flow, and cultural appropriateness of the questions.
Scoring System and Classification
Knowledge responses were scored with one point awarded for each correct answer. Cumulative scores were categorized into four levels to interpret knowledge depth:
Very Good: 17–20 points
Good: 13–16 points
Fair: 9–12 points
Poor: 0–8 points
Attitude and practice items were analyzed descriptively, with frequencies and percentages used to identify common trends and behavioral patterns.
Ethical Considerations
Informed electronic consent was obtained from all participants before starting the questionnaire. The form included a statement explaining the voluntary nature of the study, data confidentiality, anonymity, and the right to withdraw at any point. No personal identifiers were collected. The study adhered to the ethical guidelines of the Declaration of Helsinki.
Data Analysis
Data collected through Google Forms were exported to Microsoft Excel for initial organization and then analyzed using Epi Info Version 7. Descriptive statistics such as frequency distributions and percentages were used for demographic and KAP variables. Chi-square tests were applied to examine associations between knowledge scores and socio-demographic factors, with a p-value < 0.05 considered statistically significant.
Table 1 outlines the demographic distribution of the 400 respondents included in the study. The sample reflects a balanced age range, with the largest group aged 46 years and above (30.7%), followed by participants aged 26–35 (28.0%) and 36–45 (25.3%). A smaller segment (16.0%) comprised younger adults aged 18–25. Female respondents (55.2%) slightly outnumbered male participants (44.8%), offering a gender-diverse representation. Educationally, a significant proportion had completed secondary (33.5%) and undergraduate education (28.3%), while 7.8% reported no formal education, indicating some degree of educational disparity. Occupations were broadly distributed across homemakers (21.8%), private sector employees (21.5%), government employees (18.0%), and students (16.3%), highlighting the socioeconomic variety of the cohort. Notably, a higher proportion of participants were from rural areas (57.7%) compared to urban settings (42.3%), in line with the study’s emphasis on including underrepresented populations from geographically challenging regions.
Table 2 presents participants’ responses to 20 knowledge-based questions assessing awareness of postural health and its connection to musculoskeletal disorders. Overall, participants demonstrated a relatively high awareness level across several key concepts. The majority correctly identified the definition of postural health (71.5%), recognized signs of poor posture such as back or neck pain (69.5%), and acknowledged its potential to cause musculoskeletal disorders (73.8%). Respondents showed strong understanding of risk-prone professions (e.g., desk jobs), the importance of correct sitting posture (67.0%), and the benefits of exercise (78.0%) and walking (74.8%) for postural maintenance. Questions regarding ergonomics (64.8%), the use of lumbar support (62.0%), and the impact of smartphone use (69.3%) were also well-answered. However, some gaps remained in areas like long-term use of postural braces (only 62.8% answered correctly) and the role of stress in postural deterioration (66.5%), indicating a need for broader health education integrating both physical and psychosocial aspects of posture.
Table 3 categorizes participants' overall knowledge scores based on their responses to the 20-item questionnaire. A majority of respondents demonstrated either Good (34.5%) or Very Good (30.5%) knowledge regarding postural health, indicating a reasonably strong baseline understanding across the general population. Meanwhile, 22.8% scored within the Fair category and 12.2% fell into the Poor category, revealing that over one-third of the population may be inadequately informed to apply healthy postural practices consistently. This distribution suggests that although the general awareness level is encouraging, a significant proportion of individuals still lack critical knowledge, reinforcing the importance of community-based education initiatives targeting at-risk groups, such as older adults and those with lower educational attainment.
Table 1: Socio-Demographic Characteristics of Participants (n = 400)
Variable | Category | Frequency (n) | Percentage |
Age Group (Years) | 18–25 | 64 | 16.0% |
26–35 | 112 | 28.0% | |
36–45 | 101 | 25.3% | |
46 and above | 123 | 30.7% | |
Gender | Male | 179 | 44.8% |
Female | 221 | 55.2% | |
Education Level | No formal education | 31 | 7.8% |
Primary school | 66 | 16.5% | |
Secondary school | 134 | 33.5% | |
Undergraduate | 113 | 28.3% | |
Postgraduate | 56 | 14.0% | |
Occupation | Homemaker | 87 | 21.8% |
Student | 65 | 16.3% | |
Government Employee | 72 | 18.0% | |
Private Sector | 86 | 21.5% | |
Self-Employed | 52 | 13.0% | |
Retired/Other | 38 | 9.5% | |
Residence | Urban | 169 | 42.3% |
Rural | 231 | 57.7% |
Table 4 explores the relationship between participants’ knowledge scores and their socio-demographic variables using chi-square analysis. A statistically significant association was observed with age (p = 0.021), education (p < 0.001), and place of residence (p = 0.034). Participants aged 26–45 years had the highest proportion of Good and Very Good scores, possibly reflecting a more active engagement with health-related information due to occupational demands or digital exposure. Higher educational levels strongly correlated with better knowledge scores, with postgraduate and undergraduate participants showing markedly stronger understanding compared to those with no formal or primary education. Urban residents outperformed their rural counterparts, suggesting better access to information, ergonomic resources, and healthcare support. Gender was not significantly associated with knowledge levels (p = 0.279), indicating relatively balanced awareness between males and females. These findings underscore the need for targeted awareness interventions that address educational and geographic disparities in postural health literacy.
Table 2: Awareness and Knowledge Questions on Postural Health and Musculoskeletal Disorders (n = 400)
Q. No. | Question | Options (Correct in Bold) | Correct (n) | Correct (%) |
1 | What is postural health? | a) Bone density, b) Alignment of body during movement/rest, c) Blood pressure, d) Mental relaxation | 286 | 71.5% |
2 | Which is a common sign of poor posture? | a) Skin rash, b) Back or neck pain, c) Cough, d) Blurred vision | 278 | 69.5% |
3 | Can poor posture lead to musculoskeletal disorders? | a) No, b) Yes, c) Only in elderly, d) Not known | 295 | 73.8% |
4 | Which profession is at high risk of postural issues? | a) Chef, b) Desk job worker, c) Driver, d) Mason | 279 | 69.8% |
5 | What is the correct sitting posture at a desk? | a) Slouching, b) Straight spine with back support, c) Crossed legs, d) Forward lean | 268 | 67.0% |
6 | Can regular exercise help improve posture? | a) No, b) Yes, c) Depends, d) Only in athletes | 312 | 78.0% |
7 | Is prolonged smartphone use linked to posture problems? | a) No, b) Yes, c) Not proven, d) Only with gaming | 277 | 69.3% |
8 | Forward head posture mainly affects which area? | a) Lower back, b) Neck and shoulders, c) Feet, d) Arms | 281 | 70.3% |
9 | What is ergonomics? | a) Exercise, b) Science of designing workspaces to fit users, c) Nutrition, d) Posture clinic | 259 | 64.8% |
10 | Can incorrect lifting techniques cause spinal injuries? | a) No, b) Yes, c) Only in sports, d) Rarely | 293 | 73.3% |
11 | Is poor posture reversible? | a) No, b) Yes, with correction, c) Only with surgery, d) With diet | 265 | 66.3% |
12 | What device supports spinal alignment during sitting? | a) Knee pads, b) Lumbar cushion, c) Armrest, d) Mattress | 248 | 62.0% |
13 | Which sleeping position is best for spinal health? | a) On stomach, b) On back or side with support, c) Sitting, d) Legs up | 271 | 67.8% |
14 | Which age group is also vulnerable to posture-related problems? | a) Only adults, b) Children & teens, c) Seniors only, d) Newborns | 263 | 65.8% |
15 | Are postural braces a long-term solution? | a) Yes, b) No, short-term aid only, c) Must wear lifelong, d) Avoid braces | 251 | 62.8% |
16 | Can walking regularly improve postural health? | a) No, b) Yes, c) Only if fast, d) Only if gym-trained | 299 | 74.8% |
17 | Does mental stress contribute to poor posture? | a) No, b) Yes, c) Only in students, d) Only physical activity matters | 266 | 66.5% |
18 | How often should breaks be taken during long sitting? | a) Every 3 hours, b) Every 30–60 minutes, c) Once a day, d) Only when tired | 276 | 69.0% |
19 | Which activity strengthens postural muscles? | a) TV watching, b) Core strengthening exercises, c) Reading, d) Eating | 288 | 72.0% |
20 | Are musculoskeletal disorders preventable with correct posture? | a) No, b) Yes, c) Only in youth, d) Only with medicines | 301 | 75.3% |
Table 3: Knowledge Score Classification Among Participants (n = 400)
Knowledge Level | Score Range (out of 20) | Frequency (n) | Percentage |
Very Good | 17–20 | 122 | 30.5% |
Good | 13–16 | 138 | 34.5% |
Fair | 9–12 | 91 | 22.8% |
Poor | 0–8 | 49 | 12.2% |
The present study provides valuable insights into the current state of awareness, knowledge, and practices related to postural health and its implications for musculoskeletal disorders (MSDs) among the general population of Himachal Pradesh. The findings reveal a moderately high level of awareness in certain domains of postural health, yet highlight significant gaps in practical understanding and behavioral application, particularly in rural and less-educated segments of the population.
The demographic composition of the sample shows a diverse representation in terms of age, gender, education, and occupation. With a larger proportion of participants from rural areas (57.7%), the study succeeds in addressing a previously underrepresented demographic in posture-related health research. The predominance of females (55.2%) and a substantial representation of homemakers, students, and private-sector workers further strengthen the study’s inclusiveness. This demographic breadth allowed for a nuanced understanding of how postural awareness varies across socio-economic and occupational contexts.
Encouragingly, the knowledge assessment results indicate that a majority of participants correctly identified key aspects of postural health, including its definition, the impact of sedentary behavior, the role of ergonomics, and the benefits of regular physical activity. Over 70% of respondents demonstrated accurate understanding of the relationship between poor posture and common musculoskeletal complaints such as neck and back pain, which aligns with global trends recognizing sedentary lifestyle and digital device use as major risk factors. However, significant misconceptions persist, particularly regarding long-term use of postural braces, proper lifting techniques, and the interplay between stress and postural imbalance. These gaps underscore a critical need to go beyond textbook knowledge and focus on translating awareness into behavior change through community-based training and culturally tailored health promotion.
Table 4: Association Between Knowledge Score and Socio-Demographic Variables (n = 400)
Variable | Category | Very Good | Good | Fair | Poor | p-value |
Age Group | 18–25 | 14 (3.5%) | 28 (7.0%) | 15 (3.8%) | 7 (1.8%) | 0.021 |
26–35 | 39 (9.8%) | 46 (11.5%) | 20 (5.0%) | 7 (1.8%) | ||
36–45 | 34 (8.5%) | 37 (9.3%) | 19 (4.8%) | 11 (2.8%) | ||
46 and above | 35 (8.8%) | 27 (6.8%) | 37 (9.3%) | 24 (6.0%) | ||
Gender | Male | 53 (13.3%) | 62 (15.5%) | 41 (10.3%) | 23 (5.8%) | 0.279 |
Female | 69 (17.3%) | 76 (19.0%) | 50 (12.5%) | 26 (6.5%) | ||
Education Level | No formal education | 3 (0.8%) | 7 (1.8%) | 9 (2.3%) | 12 (3.0%) | <0.001 |
Primary school | 10 (2.5%) | 17 (4.3%) | 24 (6.0%) | 15 (3.8%) | ||
Secondary school | 40 (10.0%) | 51 (12.8%) | 27 (6.8%) | 16 (4.0%) | ||
Undergraduate | 42 (10.5%) | 42 (10.5%) | 21 (5.3%) | 8 (2.0%) | ||
Postgraduate | 27 (6.8%) | 21 (5.3%) | 10 (2.5%) | 3 (0.8%) | ||
Residence | Urban | 59 (14.8%) | 63 (15.8%) | 34 (8.5%) | 13 (3.3%) | 0.034 |
Rural | 63 (15.8%) | 75 (18.8%) | 57 (14.3%) | 36 (9.0%) |
The categorization of knowledge scores reinforces this observation. While nearly two-thirds of the participants fell into the Very Good or Good knowledge brackets, over one-third had only Fair or Poor knowledge. This distribution is concerning given the direct and cumulative impact of poor posture on long-term spinal health, especially in a terrain like Himachal Pradesh where daily activities often involve physically demanding and ergonomically challenging tasks. The high burden of manual labor, coupled with limited access to physiotherapists or ergonomic counseling, places these communities at greater risk of posture-related morbidity.
Statistical analysis of associations between knowledge scores and socio-demographic variables provides further clarity. Education emerged as a significant predictor of postural knowledge, with participants holding undergraduate or postgraduate degrees scoring higher compared to those with no or minimal formal education. This finding reflects a broader trend of health literacy being closely tied to educational attainment and underlines the need to integrate posture education into non-formal learning systems, such as community health worker outreach, workplace wellness programs, and school health curricula. Likewise, urban participants demonstrated higher knowledge scores than their rural counterparts, pointing to disparities in access to digital health resources, ergonomic infrastructure, and healthcare services. The age-related findings suggest that middle-aged adults (26–45 years) are more likely to be informed—likely due to occupational exposure to health awareness materials—whereas older adults lag behind, potentially due to reduced digital engagement and lower exposure to structured health messaging.
Importantly, gender was not found to significantly influence knowledge scores, which is a positive indicator of equal awareness dissemination across male and female respondents. This suggests that interventions do not need to be gender-targeted but rather should focus on bridging gaps related to geography, education, and age. However, targeted messaging may still be warranted for homemakers and retired individuals who may not encounter ergonomic education in formal or occupational settings.
In summary, the findings from this study highlight both progress and persistent challenges in the domain of postural health awareness in Himachal Pradesh. While a foundation of understanding exists, it remains insufficiently comprehensive or actionable to reduce the burden of posture-related musculoskeletal issues at a population level. The implications are particularly critical in a hilly region where physical strain is compounded by environmental and infrastructural constraints. Without timely and targeted interventions, the existing knowledge-practice gap could contribute to a rising incidence of preventable musculoskeletal disorders and associated disability [11-15].
Limitations
This study, while comprehensive in scope, is subject to certain limitations. Firstly, the reliance on a self-administered online Google Form may have excluded individuals with limited internet access or digital literacy, particularly elderly and economically disadvantaged rural residents, thereby introducing a potential selection bias. Secondly, the cross-sectional nature of the study restricts the ability to infer causality between awareness levels and musculoskeletal health outcomes. Social desirability bias may also have influenced responses, especially in questions related to healthy practices. Additionally, while the questionnaire was pilot-tested, its subjective interpretation by participants could vary. Lastly, since the sampling was non-random and convenience-based, the generalizability of findings to the entire population of Himachal Pradesh may be limited.
The study highlights a moderate to high level of public awareness regarding postural health and its role in the prevention of musculoskeletal disorders among residents of Himachal Pradesh. Although many participants demonstrated a sound understanding of postural principles and risk factors, significant knowledge gaps persist—especially among those with lower educational attainment, rural residency, and older age groups. The findings affirm the urgent need to translate awareness into consistent, health-promoting behavior. Given the physical demands of the region’s terrain and occupational lifestyle, targeted interventions addressing these disparities are crucial to reduce the long-term burden of posture-related musculoskeletal conditions and to promote healthier, more ergonomically conscious communities.
Recommendations
To address the identified gaps in postural health literacy, a multi-pronged approach is recommended. Community health programs should integrate ergonomics and postural training into their routine awareness drives, especially targeting rural populations and individuals with lower education. Educational institutions and workplaces must adopt ergonomically appropriate infrastructure and regularly conduct posture correction workshops. Mobile health units and local ASHA workers can be empowered with simplified educational material in vernacular languages to reach underserved communities. Moreover, media campaigns and digital platforms should be used strategically to disseminate information on proper posture, lifting techniques, exercise routines, and stress management. Policymakers must also incorporate postural health promotion into national and state-level non-communicable disease prevention frameworks to achieve long-term population-level impact.
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